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Perimenopause: Five steps to stay balanced

The scientific explanation of perimenopause sounds so simple: a gradual slowing down of reproductive hormones until menopause. The reality, however, is that for many women the arrival of menopause isn’t a smooth, gliding descent but more of a turbulent landing complete with bumps, twists and what can feel like the constant threat of a complete crash. Add in the physical and emotional effects of hormonal fluctuations, and the entire process can easily start to feel like a cruel joke.

Signs you may be in perimenopause

Symptoms can be subtle at first and easily mistaken for something else. They may increase gradually, or you may find they come and go along with your fluctuating hormones. They can include:

  • Changes in menstruation, which could include changes in timing (both more frequent or less frequent) and periods that are suddenly much heavier
  • Unexplained weight gain, particularly around the midsection
  • Depression
  • Brain fog
  • Hot flashes
  • Tender breasts
  • Anxiety and panic attacks
  • Restless legs
  • Insomnia and difficulty staying asleep
  • Irritability
  • Changes in libido
  • Vaginal dryness
  • Acne (as if wrinkles weren’t enough to worry about)

Five ways to find balance during perimenopause

The good news is that several lifestyle changes can help maintain hormonal balance and make it easier to cope with the changes that do occur.

1. Aim for a good night’s sleep. Waking up frequently is the most common complaint, often due to hot flashes. As always, a holistic approach helps, as a hormone-supporting diet can help regulate hot flashes.

It’s important to practice good sleep hygiene:
Avoid using electronic devices at least one hour before bedtime.
Avoid caffeine, large meals and vigorous exercise in the evening.
Build a predictable wind down routine into your evenings.
Keep your bedroom temperature on the cooler side for better sleep.
Avoid synthetic materials in bedding and sleepwear in favor of natural fabrics like cotton or linen.
Since melatonin production slows with age, melatonin supplements may be helpful.

2. Address your stress. The stress hormone cortisol rises with age, which is partly to blame for the increase in belly fat many women experience during perimenopause. Taking proactive steps to reduce stress will help get a handle on cortisol levels.

3. Get moving. Regular exercise helps with stress, reduces body fat and improves your overall quality of life. It’s important to acknowledge, however, that what worked in your 20s and 30s may not be as effective at this stage of life. Don’t feel pressure to do high-intensity workouts if your body responds better to lower-intensity programs like Pilates or walking.

4. Eat a hormone supportive diet. The concept of being gentle with your body during perimenopause extends to your diet. At this stage in life, you should focus on foods that support hormonal balance and provide nourishment:

Protein. Choose lean proteins, including some plant-based sources like chickpeas and lentils.
Fiber. Fiber helps food move smoothly through the bowels and also helps us feel fuller for longer, limiting cravings. Fiber can be found in loads of foods from flaxseed, chia seed, beans and legumes to spinach, broccoli, apples and pears.
Fat. Healthy fats, like omega-3 fatty acids, can help reduce hot flashes and may boost mood, according to some studies. Good sources of omega-3 include salmon, hemp seeds and flax seeds.

5. Manage your blood sugar and insulin levels.
High blood sugar can exacerbate hot flashes and other perimenopausal symptoms. It’s crucial to limit consumption of processed carbohydrates and sweet drinks during perimenopause, as insulin resistance becomes more commonplace. Fiber and protein can help preserve insulin sensitivity, so instead of a quick hit of something sweet for a snack, look for more satiating foods like nuts or whole grains.

A lot is happening during perimenopause for many women—career, family, decisions about the future—but taking some time to focus on your own health will help you feel empowered with the changes in your body.

Randi Mann, WHNP-BC, NCMP, APNP, is a woman’s hormone expert and the owner of Wise Woman Wellness LLC, an innovative wellness and hormone care center at 1480 Swan Road, De Pere. Mann is the author of the eBook: A Guide to Gluten and Going Gluten Free. She is a board-certified Women’s Health Nurse Practitioner and NAMS Certified Menopause Practitioner, one of a handful in Wisconsin and less than 1600 worldwide to achieve this distinction. She combines the best of conventional, functional and integrative medicine to help women with female, thyroid and adrenal hormone issues to live healthier, more abundant, joy-filled lives using a blend of compassion, cutting edge science, practical guidance and humor. Contact her at 920-339-5252 or via the Internet at Join the introductory virtual seminar, “End Hormone Havoc – Crazy Hormones Cause Fatigue, Weight Gain and Brain Fog and How to Fix Them!” offered monthly, to learn about specialized thyroid, adrenal and female hormone testing and customized, bioidentical hormone treatments to achieve lifelong optimal hormone balance, increased vitality and longevity.

Sources: “Sleep problems during the menopausal transition: prevalence, impact, and management challenges.” Nat Sci Sleep. 2018 – Fiona C Baker, corresponding author1,2 Massimiliano de Zambotti,1 Ian M Colrain,1,3 and Bei Bei.
“Melatonin, human aging, and age-related diseases.” Exp Gerontol. Nov-Dec 2004 – M Karasek.
“Mindfulness Training for Coping with Hot Flashes: Results of a Randomized Trial Menopause.” 2011 – James Carmody, Ph.D., Associate Professor of Medicine, corresponding author Sybil Crawford, Ph.D., Professor of Medicine, Elena Salmoirago-Blotcher, M.D., Doctoral Fellow, et al.
“Cortisol Levels during the Menopausal Transition and Early Postmenopause: Observations from the Seattle Midlife Women’s Health Study.” Menopause 2009 – Nancy Fugate Woods, PhD, RN, FAAN, Ellen Sullivan Mitchell, PhD, and Kathleen Smith-DiJulio, PhD, RN.
“The role of calcium in peri-and postmenopausal women: consensus opinion of The North American Menopause Society.” Menopause 2001 – The North American Menopause Society.
Depression and emotional aspects of the menopause – bcmj, October 2001 By: Diana Carter, MBBS.
“Omega-3 fatty acids for major depressive disorder associated with the menopausal transition: a preliminary open trial.” PMC 2011 – Marlene P. Freeman, MD,1 Joseph R. Hibbeln, MD,2 Michael Silver, MS et al.
“Vasomotor symptoms and insulin resistance in the study of women’s health across the nation.” J Clin Endocrinol Metab. 2012 – Rebecca C Thurston 1, Samar R El Khoudary et al.
“…for many women the arrival of menopause isn’t a smooth, gliding descent but more of a turbulent landing complete with bumps, twists and what can feel like the constant threat of a complete crash.”

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